| NPI | 1689963134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL OS12971) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS12971) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2020-02-18 |